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14 Articles in Volume 18, Issue #9
Assessing Arthralgia in Children
Children, Opioids, and Pain: The Stats & Clinical Guidelines
How to Fit into a New Practice
How to Talk to Your Chronic Pain Patients
How to Treat Opioid Use Disorder in Pregnant Women
Intranasal Ketamine for Acute Pain in Children
Medication Selection for Comorbid Pain Management (Part 3)
MR Neurography: Using Peripheral Nerve Imaging as a Pain Diagnostic
Naloxone in Schools; Buprenorphine Conversions; OUD Management
Opioid Conversion Calculations and Changes
Pes Anserine Tendino-Bursitis as Primary Cause of Knee Pain in Overweight Women
Self-Management of Chronic Pain in Primary Care
The Homebound Adolescent: Managing Chronic Pain Conditions in the Pediatric Population
The Opioid Band-Aid: The State of Pain Pills, Congressional Bills, and Healthcare in the US

Children, Opioids, and Pain: The Stats & Clinical Guidelines

Consensus guidelines for prescribing opioids to children and adolescents are lacking.
Pages 18-20
Page 2 of 2
  • Providers should only consider adding opioid therapy if expected benefits for both pain and function are anticipated to outweigh risks.
  • Providers should prescribe short-acting opioids. When opioids are used for acute pain, providers should prescribe the lowest effective dose of short-acting opioids and should prescribe no greater quantity than needed for the expected duration of pain. Incorporate strategies to mitigate risk including mental health concerns, patient or family risk of addiction.
  • Clinicians should review the patient’s history of controlled substance prescriptions to determine whether the patient is receiving excessive opioid dosages or dangerous combinations. Use urine drug testing before starting opioids for chronic pain.
  • Clinicians should prescribe the lowest possible effective dosage. Providers should evaluate patients within 1 to 4 weeks of starting dose escalation to assess benefits and harms of continued opioid therapy. Providers should evaluate patients every 3 months, or more frequently for benefits and harms of continued opioid therapy.

Children’s Hospital Colorado (Aurora, CO)5

  • Providers should proceed with cautious use and prescription of opioid therapy, limiting the amount prescribed while ensuring pain management.
  • No long-acting opioids may be prescribed in the emergency department/urgent care. It is recommended to avoid long-acting opioids in inpatient and surgical settings as well.
  • Clinicians should recommend the use of non-pharmacologic and multimodal approaches to pain management.
  • If pharmacogenomic testing is available or has been completed, it should be considered for all patients.

Pennsylvania State Guidelines6

  • Opioid analgesics should be reserved for those children and adolescents with moderate to severe pain. Children in need of these medications most often are post-
    operative patients and those with sickle cell crisis, cancer, or those receiving palliative or end-of-life care.
  • The opioids of choice when treating children for moderate to severe pain are morphine or oxycodone.
  • Combination medications with set amounts of an opioid paired with a set amount of either acetaminophen or ibuprofen are to be avoided since the dose of one or two medications in the pair is likely to be too low or too high. It is better to prescribe these medications separately.

It is important to note that children are affected by opioids directly but also indirectly. Bipartisan opioid law7 signed by President Trump in October 2018 aims to address the adolescent population affected by family members who may have an Opioid Use Disorder (see more regarding pregnancy and opioid use on page 29). According to the legislation, the US Department of Health and Human Services must begin to provide resources to early childhood care and education providers and other professionals working with young children on how they can “recognize and respond to children” who may be affected by such circumstances. The healthcare community also continues to address the challenge of neonatal abstinence syndrome, and FDA is supporting the development of new children’s medical devices through its Pediatric Device Consortia.

 

-Reported by Steven Aliano

 

Last updated on: December 5, 2018
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Intranasal Ketamine for Acute Pain in Children
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